Evaluation and Management of Laryngopharyngeal Reflux Disease: An Updated State of the Art Review
Year: 2026
Type: article
Study design: Systematic Review
Abstract: OBJECTIVE: To review the updated literature about epidemiology, clinical presentation, diagnosis, and treatment of laryngopharyngeal reflux disease (LPRD) and to provide a practical management for clinical practice. DATA SOURCES: PubMED, Cochrane Library, and Scopus. REVIEW METHOD: Four authors conducted the literature review on LPRD epidemiology, clinical presentation, diagnosis, and treatment according to the PRISMA statement. A critical analysis of the literature and a related management algorithm for clinical practice were provided. CONCLUSIONS: Studies from the last 5 years provided increased evidence about the gaseous and alkaline profile of LPRD at 24-hour hypopharyngeal-esophageal impedance-pH monitoring, and the presence of alkaline-activated enzymes in the upper aerodigestive tract mucosa. Three consensuses emerged, emphasizing the importance of objective testing to demonstrate LPRD in patients with laryngopharyngeal symptoms. The recent literature suggested that LPRD may be associated with atypical presentations, including posterior nasal inflammation, dry eyes, and middle ear disorders. The predominantly alkaline nature of LPRD has prompted clinical studies supporting alginate and magaldrate over proton pump inhibitors (PPIs), which only target gastric acidity, for managing acid, weakly acid, and alkaline pharyngeal reflux events. Despite a growing literature, there was no randomized controlled trial comparing alginate, magaldrate, diet, and PPIs conducted in the last 5 years. IMPLICATIONS FOR PRACTICE: The increased evidence about alkalinity of pharyngeal reflux events and the detection of alkaline-activated enzymes in saliva may shift the current PPI-based therapy to alginate therapy. Multicenter international randomized controlled studies with standardized protocols could improve the scientific knowledge about LPRD.
Source: Otolaryngology
DOI: 10.1002/ohn.70413
Authors: Jerome R. Lechien, Nikki Johnston, Edoardo Savarino, Abdul Latif Hamdan, Maria Rosaria Barillari, Jonathan M. Bock, Young‐Gyu Eun, Jinrang Li, Michael F. Vaezi, Jacqueline E. Allen, Karol Zelenik, Peter C. Belafsky, Giovanni Dapri, Claudia A. Eckley, Toshitaka Hoppo, Robert T. Sataloff, Lee M. Akst, Antonino Maniaci, Luigi A. Vaira, Petros D. Karkos, Walter W. Chan, Inna A. Husain, Thomas L. Carroll
Institutions: University of Mons, Université Paris-Saclay, Medical College of Wisconsin, University of Padua, American University of Beirut Medical Center, American University of Beirut, Kyung Hee University, Chinese PLA General Hospital, Vanderbilt University, Vanderbilt University Medical Center, University of Auckland, University of Ostrava, University Hospital Ostrava, University of California Davis Medical Center, Humanitas Gavazzeni, Fleury S.A. (Brazil), Rutgers, The State University of New Jersey, Drexel University, Johns Hopkins University, University of Sassari, Aristotle University of Thessaloniki, AHEPA University Hospital, Brigham and Women's Hospital, Harvard University
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7204235624